MEDICARE: DR. GOLNAR KHALILI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	009784	CT

General Provider Information

NPI Number	:	1962691543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOLNAR KHALILI DDS

Provider Business Mailing Address
First Line	:	54 MAIN ST
Second Line	:	F
City	:	DANBURY
State	:	CT
Zip	:	06810-3009
Country	:	US
Telephone Number	:	203-790-0111
Fax Number	:	203-797-0822

Provider Business Practice Location Address
First Line	:	54 MAIN ST
Second Line	:	F
City	:	DANBURY
State	:	CT
Zip	:	06810-3009
Country	:	US
Telephone Number	:	203-790-0111
Fax Number	:	203-797-0822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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